 |
|
Chronic Cryptogenic Sensory Polyneuropathy
Clinical and Laboratory Characteristics
Gil I. Wolfe, MD;
Noel S. Baker, MD;
Anthony A. Amato, MD;
Carlayne E. Jackson, MD;
Sharon P. Nations, MD;
David S. Saperstein, MD;
Choon H. Cha, MD;
Jonathan S. Katz, MD;
Wilson W. Bryan, MD;
Richard J. Barohn, MD
Arch Neurol. 1999;56:540-547.
Background Chronic sensory-predominant polyneuropathy (PN) is a common clinical problem confronting neurologists. Even with modern diagnostic approaches, many of these PNs remain unclassified.
Objective To better define the clinical and laboratory characteristics of a large group of patients with cryptogenic sensory polyneuropathy (CSPN) evaluated in 2 university-based neuromuscular clinics.
Design Medical record review of patients evaluated for PN during a 2-year period. We defined CSPN on the basis of pain, numbness, and tingling in the distal extremities without symptoms of weakness. Sensory symptoms and signs had to evolve for at least 3 months in a roughly symmetrical pattern. Identifiable causes of PN were excluded by history, physical examination findings, and results of laboratory studies. We analyzed clinical and laboratory data from patients with CSPN and compared findings in patients with and without pain.
Results Of 402 patients with PN, 93 (23.1%) had CSPN and stable to slowly progressive PN syndrome. These patients presented with a mean age of 63.2 years and a mean duration of symptoms of 62.9 months. Symptoms almost always started in the feet and included distal numbness or tingling in 86% of patients and pain in 72% of patients. Despite the absence of motor symptoms at presentation, results of motor nerve conduction studies were abnormal in 60% of patients, and electromyographic evidence of denervation was observed in 70% of patients. Results of laboratory studies were consistent with axonal degeneration. Patients with and without pain were similar regarding physical findings and laboratory test abnormalities. Only a few patients (<5%) had no evidence of large-fiber dysfunction on physical examination or electrophysiologic studies. All 66 patients who had follow-up examinations (mean, 12.5 months) remained ambulatory.
Conclusions Cryptogenic sensory polyneuropathy is a common, slowly progressive neuropathy that begins in late adulthood and causes limited motor impairment. Isolated small-fiber involvement is uncommon in this group of patients. Management should focus on rational pharmacotherapy of neuropathic pain combined with reassurance of CSPN's benign clinical course.
From the Departments of Neurology, University of Texas Southwestern Medical Center, Dallas (Drs Wolfe, Baker, Nations, Saperstein, Cha, Katz, Bryan, and Barohn), and University of Texas Health Sciences Center, San Antonio (Drs Amato and Jackson).
RELATED ARTICLES
Cryptogenic Sensory Polyneuropathy
Peter James Dyck
Arch Neurol. 1999;56(5):519-520.
EXTRACT
| FULL TEXT
Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 1999;56(5):634-636.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Value of the Oral Glucose Tolerance Test in the Evaluation of Chronic Idiopathic Axonal Polyneuropathy
Hoffman-Snyder et al.
Arch Neurol 2006;63:1075-1079.
ABSTRACT
| FULL TEXT
Clinical spectrum of cryoglobulinaemic neuropathy
Gemignani et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1410-1414.
ABSTRACT
| FULL TEXT
SPTLC1 and RAB7 mutation analysis in dominantly inherited and idiopathic sensory neuropathies
Klein et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1022-1024.
ABSTRACT
| FULL TEXT
Follow up of patients with signs and symptoms of polyneuropathy not confirmed by electrophysiological studies
Rosenberg et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:879-881.
ABSTRACT
| FULL TEXT
Plantar nerve AP and skin biopsy in sensory neuropathies with normal routine conduction studies
Herrmann et al.
Neurology 2004;63:879-885.
ABSTRACT
| FULL TEXT
A controlled investigation of the cause of chronic idiopathic axonal polyneuropathy
Hughes et al.
Brain 2004;127:1723-1730.
ABSTRACT
| FULL TEXT
The Diagnostic Yield of a Standardized Approach to Idiopathic Sensory-Predominant Neuropathy
Smith and Singleton
Arch Intern Med 2004;164:1021-1025.
ABSTRACT
| FULL TEXT
Challenges in the Identification of Cobalamin-Deficiency Polyneuropathy
Saperstein et al.
Arch Neurol 2003;60:1296-1301.
ABSTRACT
| FULL TEXT
Prevalence of Vasculitic Neuropathy in Wegener Granulomatosis
Collins et al.
Arch Neurol 2002;59:1333-1334.
FULL TEXT
Is cardiovascular disease a risk factor in the development of axonal polyneuropathy?
Teunissen et al.
J. Neurol. Neurosurg. Psychiatry 2002;72:590-595.
ABSTRACT
| FULL TEXT
Chronic Idiopathic Axonal Polyneuropathy and Successful Aging of the Peripheral Nervous System in Elderly People
Vrancken et al.
Arch Neurol 2002;59:533-540.
ABSTRACT
| FULL TEXT
Increased Prevalence of Impaired Glucose Tolerance in Patients With Painful Sensory Neuropathy
Singleton et al.
Diabetes Care 2001;24:1448-1453.
ABSTRACT
| FULL TEXT
Sensory Guillain-Barre syndrome
Oh et al.
Neurology 2001;56:82-86.
ABSTRACT
| FULL TEXT
Pharmacologic treatment of pain in polyneuropathy
Sindrup and Jensen
Neurology 2000;55:915-920.
ABSTRACT
| FULL TEXT
Chronic Cryptogenic Sensory Polyneuropathy
Lauria et al.
Arch Neurol 2000;57:759-760.
FULL TEXT
Distal acquired demyelinating symmetric neuropathy
Katz et al.
Neurology 2000;54:615-615.
ABSTRACT
| FULL TEXT
Sensory Polyneuropathy of Unknown Cause
JWatch General 1999;1999:7-7.
FULL TEXT
Cryptogenic Sensory Polyneuropathy
Dyck
Arch Neurol 1999;56:519-520.
FULL TEXT
Intraepidermal Nerve Fiber Assessment: A New Window on Peripheral Neuropathy
Barohn
Arch Neurol 1998;55:1505-1506.
FULL TEXT
|
